| Name: | Shoals Medical Group, LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Dissolved |
| Date of registration: | 13 Nov 2008 (16 years ago) (Companies founded in November 2008) |
| Date of dissolution: | 14 Oct 2016 |
| Entity Number: | 000-427-164 |
| Register Number: | 000427164 |
| Historical Names: |
Shoals Medical Group, LLC
Shoals Medical Group, Inc. |
| ZIP code: | 35660 (Companies in Colbert, 35660) |
| County: | Colbert |
| Place of Formation: | Colbert County |
| Principal Address: | 1120 SOUTH JACKSON HWY SUITE 301-BSHEFFIELD, AL 35660 |
| Registered Office Street Address: | 1120 SOUTH JACKSON HWY STE 301 BSHEFFIELD, AL 35660 |
Activities
PRIMARY CARE/CLINICAL MANAGEMENT OF PATIENTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1891930491 | 2008-12-10 | 2010-04-23 | 1120 S JACKSON HWY, SUITE 301-B, SHEFFIELD, AL, 356605777, US | 1120 S JACKSON HWY, SUITE 301-B, SHEFFIELD, AL, 356605777, US | |||||||||||||||||||
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| Phone | +1 256-320-5405 |
| Fax | 2563205407 |
Authorized person
| Name | DR. MOHAMMAD SIDDIQUE |
| Role | DIRECTOR |
| Phone | 2563205405 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | 22371 |
| State | AL |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHOALS MEDICAL GROUP, LLC PROFIT SHARING PLAN | 2015 | 300512613 | 2016-10-16 | SHOALS MEDICAL GROUP, LLC | 4 | |||||||||||||||||||||
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| SHOALS MEDICAL GROUP, LLC DEFINED BENEFIT PLAN | 2015 | 300512631 | 2016-10-16 | SHOALS MEDICAL GROUP, LLC | 4 | |||||||||||||||||||||
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| SHOALS MEDICAL GROUP LLC DEFINED BENEFIT PLAN | 2014 | 300512631 | 2015-10-11 | SHOALS MEDICAL GROUP, LLC | 4 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2015-10-11 |
| Name of individual signing | MOHAMMAD SIDDIQUE |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2013-01-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 2563205405 |
| Plan sponsor’s address | 1120 SOUTH JACKSON HWY, SUITE 301-B, SHEFFIELD, AL, 35660 |
Signature of
| Role | Plan administrator |
| Date | 2015-10-11 |
| Name of individual signing | MOHAMMAD SIDDIQUE |
| Name | Role | Address |
|---|---|---|
| SIDDIQUE, MOHAMMAD | Agent | 1120 SOUTH JACKSON HWY STE 301 BSHEFFIELD, AL 35660 |
| Name | Role | Address |
|---|---|---|
| SIDDIQUE, MOHAMMAD | Organizer | 1120 SOUTH JACKSON HWY STE 301 BSHEFFIELD, AL 35660 |
| SIDDIQUE, SHAHEEN SULTANA | Organizer | 1120 SOUTH JACKSON HWY STE 301 BSHEFFIELD, AL 35660 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2014-08-01 | Name Change | Shoals Medical Group, Inc. | Shoals Medical Group, LLC |
| 2013-10-31 | Name Change | Shoals Medical Group, LLC | Shoals Medical Group, Inc. |
Date of last update: 13 Aug 2024
Sources: Alabama Secretary of State
